| Amethyst House, Inc. | |
|
645 N Walnut St Bloomington IN 47404-3846 | |
| (812) 336-3570 | |
| (812) 336-9010 |
| Full Name | Amethyst House, Inc. |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 645 N Walnut St, Bloomington, Indiana |
| Authorized Official Name and Position | Mark Delong (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8123363570 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amethyst House, Inc. Po Box 11 Bloomington IN 47402-0011 Ph: (812) 336-3570 | Amethyst House, Inc. 645 N Walnut St Bloomington IN 47404-3846 Ph: (812) 336-3570 |
| NPI Number | 1770709230 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 09/26/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770709230 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1279-0 ASR (Indiana) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | 1279-0 CA (Indiana) | Primary |
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